Home Health vs Nursing Home After Hospital: Who Pays in 2026
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Key takeaways
- Medicare home health is for a person who is homebound, needs part-time or intermittent skilled care, has had a face-to-face visit, and gets care from a Medicare-participating agency under a plan of care.
- Medicare covers a skilled nursing facility when a person needs skilled nursing or rehab daily (skilled rehab at least 5 days a week when it isn't offered 7 days a week) that can only be given as an inpatient in the facility. Original Medicare also generally requires an inpatient hospital stay of at least 3 days in a row; Medicare.gov says this may not be needed if the doctor is in an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver.
- A hospital stay is not required for Medicare home health, according to CMS's Benefit Policy Manual.
- In 2026, covered home health services cost $0 under Original Medicare. In a skilled nursing facility the patient pays $0 a day for days 1-20 after the $1,736 Part A deductible, $217 a day for days 21-100, and all costs after day 100.
- Neither setting is covered when custodial care, such as help with bathing or dressing, is the only care needed. Medicare home health does not pay for 24-hour care at home.
Short answer
Medicare can pay for either one after a hospital stay, but the rules are different. Home health is for a person who is homebound and needs part-time or intermittent skilled care, and covered visits cost $0. A skilled nursing facility (SNF) is for a person who needs skilled nursing or rehab daily (skilled rehab at least 5 days a week when it isn't offered 7 days a week) that can only be given in the facility, and under Original Medicare it generally requires a 3-day inpatient hospital stay; Medicare.gov says this may not be needed if the doctor is in an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver.
Compare Medicare-certified home health agencies by ZIP code, or search nursing homes by name, city or ZIP on the home page and compare nursing homes side by side.
Home health vs. a nursing home after the hospital: side by side
The biggest differences are how much skilled care is needed each day and whether a hospital stay is required. This table compares the two under Original Medicare.
| Question | Home health | Skilled nursing facility |
|---|---|---|
| Where is the care given? | At home, in visits | In the facility, as an inpatient |
| Hospital stay needed? | No | Yes: 3 inpatient days in a row, with limited exceptions |
| How much skilled care? | Part-time or intermittent | Daily (skilled rehab at least 5 days a week if not offered 7 days) |
| Must be homebound? | Yes | No |
| Room and meals covered? | No | Semi-private room and meals |
| Cost in 2026 | $0 for covered services | $0 days 1–20, then $217 a day |
| Day or visit limit | No set visit limit | Up to 100 days per benefit period |
Who qualifies for Medicare home health?
Federal rules (42 CFR 409.42) say a person qualifies for Medicare home health only if they meet all five of these conditions:
- Confined to the home (homebound).
- Under the care of a doctor or allowed practitioner who sets up the plan of care.
- Needs at least one skilled service: intermittent skilled nursing, physical therapy or speech-language pathology.
- Under a plan of care that names the treatments, the type of staff and how often visits happen.
- Gets care from a Medicare-participating home health agency, or one that agency arranges.
Occupational therapy alone generally can't start home health. Medicare.gov says it must first be ordered along with nursing care, physical therapy or speech-language pathology, and after that it can continue on its own.
What "homebound" means. Under the Medicare law, a person is confined to the home if illness or injury means they can leave only with help from another person or a device such as a cane, walker or wheelchair, or if leaving home is medically not advised. They don't have to be bedridden, but leaving home must normally take a considerable and taxing effort. The law says trips for health care, including regular adult day care for treatment in a program that is licensed or certified by a state, or accredited, don't disqualify a person. Short or infrequent outings, such as religious services, don't either.
An in-person visit is required. Federal rules say the certifying doctor or allowed practitioner must document a face-to-face visit related to the main reason for home health. It must happen no more than 90 days before, or within 30 days after, home health starts. It can be done by telehealth under Medicare's telehealth rules.
"Part-time or intermittent." The Medicare law defines this as skilled nursing and home health aide services, combined, of less than 8 hours each day and 28 or fewer hours each week. Case by case, it can be less than 8 hours each day and up to 35 hours each week. Medicare.gov says a person won't qualify for home health if they need more than part-time or intermittent skilled care.
Who qualifies for Medicare coverage in a skilled nursing facility?
Federal rules (42 CFR 409.30–409.31) say Original Medicare Part A covers SNF care only when these are true:
- The person had a medically necessary inpatient hospital stay of at least 3 days in a row, not counting the day of discharge. Medicare says time under observation, or in the emergency room before admission, doesn't count. Medicare.gov says the 3-day stay may not be needed if the doctor participates in an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver.
- The person generally enters the SNF within 30 days after leaving the hospital. The rules allow a later start when SNF care would not be medically appropriate within 30 days.
- The person needs skilled nursing or rehab daily (skilled rehab at least 5 days a week when it isn't offered 7 days a week) that, as a practical matter, can only be given as an inpatient in a SNF, for a condition treated in the hospital (or one that arose in the SNF).
For both home health and SNF care, federal rules say the chance of getting better is not the deciding factor. A person may still need skilled care to keep from getting worse or to keep the abilities they have now. For more on the SNF side, see how to choose a nursing home before hospital discharge.
What does each option cost in 2026?
Under Original Medicare, covered home health services cost $0, while SNF care is $0 only for the first 20 days.
Home health. Medicare.gov says you pay nothing for covered home health services. For Medicare-covered medical equipment, you pay 20% of the Medicare-approved amount after the Part B deductible. A CMS manual says a hospital stay isn't required: for people with Part A and Part B, Part A pays for up to 100 visits when home health starts within 14 days after a 3-day inpatient stay or a covered SNF stay, and otherwise Part B pays, including for people coming from the community.
Skilled nursing facility. In 2026, Medicare says the patient pays:
- Days 1–20: $0 a day, after the $1,736 Part A deductible. Medicare says the deductible isn't charged again if it was already paid for hospital care in the same benefit period.
- Days 21–100: $217 a day.
- Day 101 on: all costs.
Medicare Advantage. Medicare says Medicare Advantage plans may charge copays during the first 20 SNF days and may waive the 3-day hospital stay. For home health, Medicare.gov says to check with the plan. A CMS booklet says a plan may require using home health agencies it contracts with.
Written notice before you're charged. A CMS booklet says the home health agency must give a written Advance Beneficiary Notice of Noncoverage (ABN) before giving a service or supply Medicare probably won't cover.
What doesn't Medicare cover in either setting?
Medicare doesn't pay for custodial care, such as help with bathing, dressing or using the bathroom, when that is the only care a person needs, at home or in a nursing home. Medicare.gov also lists these as not covered under home health:
- 24-hour-a-day care at home.
- Home meal delivery.
- Homemaker services, like shopping and cleaning, that are unrelated to the care plan.
Medicare.gov says a home health aide can help with bathing or walking only when the person also gets skilled nursing or therapy. In a SNF, Medicare stops paying after day 100 of a benefit period, or sooner when daily skilled care is no longer needed. See short-term rehab vs. long-term care and does Medicare cover nursing homes for what happens next.
How do you choose a home health agency or a nursing home?
The patient and family choose. A CMS booklet says you have a say in which home health agency you use, and the doctor or hospital discharge planner should honor your choice, though agency availability or insurance can limit it. Medicare.gov says the provider should give a list of agencies that serve your area and disclose any financial interest in them. Federal hospital rules also require a list of Medicare-participating SNFs in the area the patient asks for, and free choice among them.
- Look up agencies that serve a ZIP code and their CMS star ratings in our home health agency directory.
- Check each nursing home on the hospital's list: search on the nursing home search page, then compare star ratings, staffing and inspections side by side.
- If an inpatient rehabilitation facility (rehab hospital) is also an option, see its CMS quality data in our inpatient rehabilitation facility directory.
Questions to ask the hospital discharge planner
These questions follow the rules above.
- Is the patient an inpatient or under observation, and how many inpatient days count toward the 3-day stay?
- What skilled care does the patient need: daily, or a few visits a week?
- Does the doctor consider the patient homebound, and who will do or document the face-to-face visit for home health?
- Can we have the list of home health agencies and SNFs that serve our area? Does the hospital have a financial interest in any of them?
- If the patient has a Medicare Advantage plan: which agencies and facilities are in the network, and does the plan need to approve the care first?
- Who will help with bathing, dressing and meals between home health visits?
For questions about coverage, you can call 1-800-MEDICARE (1-800-633-4227). If the patient is being discharged too soon, the hospital's Important Message from Medicare explains how to ask the BFCC-QIO for a fast appeal; see our hospital discharge guide.